Pharmacologic basis for the treatment of cardiac arrhythmias

H. Gelband, M. R. Rosen

Research output: Contribution to journalReview article

13 Scopus citations

Abstract

Information and experience here are often limited, and in many instances the determining factor in selection and method of administration of a drug to the pediatric patient is its use in the treatment of arrhythmias in the adult. Additional requirements for the rational choice of the proper antiarrhythmic agent are an accurate diagnosis of the cardiac arrhythmia; a knowledge of the mechanism for initiation and maintenace of an arrhythmia; an understanding of the electrophysiologic effects, pharmacologic properties and metabolism of the drugs available; and the clinical status of the patient. Any electrolyte imbalance, concomitant drug therapy or organ system dysfunction may alter the absorption and metabolism of the drug. Although the simultaneous use of combinations of arrhythmic drugs in the initial treatment of arrhythmias appears to be a common clinical practice, the authors do not recommend this. When more than one drug is administered it is difficult to determine which is responsible for a therapeutic effect, and equally important which is responsible for undesirable effects should they occur. Hence, it is preferable to employ single drug therapy with frequent clinical evaluations and determinations of plasma concentrations as a guide in the management of the arrhythmia. Since sparse information is available concerning the pharmacokinetics of antiarrhythmic drugs in pediatric patients, the pediatric patient may require higher doses of a specific drug on a per kilogram basis to control his arrhythmia than would be required by an adult, as evidenced by the use of procaineamide and digitalis. When therapeutic doses or plasma concentrations of antiarrhythmic drugs fail to produce a desired antiarrhythmic effect, the drug should be continued to be administered cautiously in increasing amounts until minimal toxic manifestations occur or the arrhythmia is terminated. In instances where a specific single drug fails, another antiarrhythmic agent should be resorted to. Combined drug therapy should be utilized only when the use of single agents fails.

Original languageEnglish (US)
Pages (from-to)59-67
Number of pages9
JournalPediatrics
Volume55
Issue number1
StatePublished - Dec 1 1975

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Gelband, H., & Rosen, M. R. (1975). Pharmacologic basis for the treatment of cardiac arrhythmias. Pediatrics, 55(1), 59-67.